A concussion diagnosis explains that the brain was injured, but it does not automatically reveal which neurological systems were affected or which treatment should come first.
Two patients may report the same headaches, dizziness, light sensitivity, and fatigue while having very different problems involving eye movements, balance, the brainstem, or the brain’s ability to produce energy.
During this episode of Mind Matters: Navigating Head Injuries and Concussions, attorney Thomas Ozbolt spoke with Dr. Darcy Dane, a chiropractic neurologist and owner of Carolina Brain Center in Raleigh, North Carolina. They discussed neuroplasticity, the brain’s visual and vestibular pathways, the neurometabolic cascade of concussion, and why rehabilitation must be built around the individual patient.
A Concussion Diagnosis Is Only the Starting Point
Dr. Dane explained that recognizing a concussion may be the easier part of the evaluation.
The patient can describe the accident, the forces involved, and the symptoms that followed. The more difficult question is determining what the injury disrupted and how those problems should be treated.
Many concussions improve with time. Others continue producing symptoms for four to six weeks or longer.
A patient may initially feel better and then notice headaches, dizziness, visual problems, or fatigue returning as normal activity increases.
When symptoms persist, simply repeating the diagnosis is not enough. The provider must investigate which brain systems are not functioning properly.
The Eyes Reveal How the Brain Is Working
Dr. Dane described the eyes as a window into brain function.
Different eye movements depend on different neurological pathways.
Saccades are rapid eye movements that shift focus from one target to another. Looking toward something that suddenly enters the visual field may involve a different pathway than looking toward a location remembered from a moment earlier.
Smooth pursuits allow the eyes to follow a moving object, such as a plane crossing the sky.
If those movements are delayed, inaccurate, or choppy, the findings may provide clues about problems involving the frontal lobes, parietal lobes, brainstem, cerebellum, or their connections.
No single eye test can explain the entire injury. Providers must compare several findings with the patient’s symptoms and physical examination.
Vision and Balance Must Stay Synchronized
People use their eyes, inner ears, muscles, and joints to understand where they are in space.
The visual system reports what is moving in the environment. The vestibular system helps detect head movement and balance. Muscles and joints provide information about body position.
These signals normally work together automatically.
After a concussion, one system may begin sending information that does not match the others. The brain must then use extra effort to remain oriented and upright.
This mismatch may contribute to:
- Dizziness
- Poor balance
- Motion sensitivity
- Blurred vision
- Headaches
- Difficulty reading
- Discomfort in traffic
- Feeling overwhelmed in stores
Detailed testing may help determine whether the visual system, vestibular system, or their coordination needs rehabilitation.
Neuroplasticity Supports Recovery
Neuroplasticity is the brain’s ability to form and strengthen connections.
Dr. Dane compared an injured pathway to wiring that has become frayed. Rehabilitation attempts to improve communication and help the brain create more effective connections.
A provider may use brain regions that are functioning well to support areas that are struggling.
However, the brain operates as an interconnected system. Stimulating one area may also affect several others.
Dr. Dane compared that effect to dropping a stone into water and watching the ripples spread outward. The treatment must be selected carefully so that it supports the injured system without overwhelming it.
There Is No Cookie-Cutter Concussion Plan
Patients with similar symptoms may require very different treatment plans.
One patient’s dizziness may come primarily from vestibular dysfunction. Another may have abnormal eye movements, neck-related problems, or poor coordination between multiple systems.
Even the patient’s response to an exercise provides useful information.
If a treatment causes an extreme increase in nausea, headaches, dizziness, or fatigue, the provider may need to:
- Reduce the intensity
- Shorten the session
- Select a different exercise
- Treat another system first
- Allow more recovery between activities
Rehabilitation should challenge the brain enough to encourage improvement without exceeding its current capacity.
The Brain Can Enter an Energy Crisis
Dr. Dane also discussed the neurometabolic cascade of concussion.
After the injury, the brain experiences changes involving neurotransmitters, minerals, and cellular energy.
Glutamate, an excitatory neurotransmitter, may increase. Potassium may move out of cells, and the brain must use additional energy to restore its normal chemical balance.
At the same time, injured cells may have difficulty accessing and using glucose efficiently.
This creates an energy crisis: the brain needs more fuel to recover but may be temporarily less capable of using its usual source of energy.
Symptoms associated with this process may include:
- Light sensitivity
- Noise sensitivity
- Irritability
- Fatigue
- Poor sleep
- Headaches
- Reduced stamina
- Cognitive difficulty
Dr. Dane described the metabolic component as an important consideration when deciding when and how aggressively to begin rehabilitation.
Sometimes Intensive Therapy Begins Too Soon
A patient may be sent directly into vestibular therapy because dizziness is the most obvious symptom.
However, if the injured brain is already struggling to meet its energy demands, demanding exercises may cause a severe symptom flare.
The patient may leave therapy feeling nauseated, exhausted, or significantly worse and eventually stop attending.
That does not necessarily mean vestibular rehabilitation will never help.
It may mean the brain was not ready for that intensity or that another problem needed to be addressed first.
Dr. Dane emphasized the importance of knowing when to treat, when to wait, and how to build the program gradually.
Whiplash Can Cause Concussion Symptoms
A person does not have to strike their head to experience a concussion.
During whiplash, the brain can move inside the skull as the head rapidly changes direction. Nerve fibers may stretch, and brainstem areas involved in vision, balance, and coordination may be affected.
A rear-end collision may involve several movements within seconds.
The body moves forward, the head may contact the headrest, and then the person may move forward again. This creates more than one acceleration and deceleration force during a single crash.
Dr. Dane explained that whiplash and concussion symptoms may substantially overlap, which is why the neurological aspects of the injury should not be ignored simply because there was no reported head strike.
One Event May Include Multiple Impacts
The number of forces experienced during an event can also matter.
A collision may involve the initial impact, contact with the seat or headrest, and additional movement as the vehicle rotates or strikes another object.
Sports injuries and assaults may involve repeated blows within a short period.
A provider should therefore look beyond whether the patient experienced “one concussion” and examine the complete mechanism, including the direction and number of impacts.
Previous concussions may also affect how the brain responds to another injury.
Health Before the Injury Can Affect Recovery
Dr. Dane discussed several factors that may complicate concussion recovery:
- Previous brain injuries
- A developing brain
- Learning disabilities
- Mood disorders
- Autoimmune conditions
- Existing inflammation
Children and adolescents may respond differently because their brains are still developing.
Someone with an autoimmune condition may already have increased inflammation before the accident. A person with a mood disorder or learning disability may also experience a more complicated recovery.
These factors do not mean the patient cannot improve.
They help the provider determine how much stimulation the brain can tolerate and which problems should be addressed first.
Treatment Should Follow the Findings
A complete concussion evaluation may examine:
- Eye movements
- Vestibular function
- Balance
- Coordination
- Brainstem pathways
- Cognitive processing
- Symptom response to activity
- Medical history
- Previous injuries
- Metabolic concerns
The resulting plan may include visual exercises, vestibular rehabilitation, balance training, movement, neck treatment, cognitive care, or other individualized approaches.
Dr. Dane also discussed using hyperbaric oxygen and ketone therapy within her practice. These remain developing areas of concussion care, and the transcript reflects her clinical approach rather than establishing that they are appropriate for every patient.
Any emerging treatment should be discussed with a qualified healthcare provider who can evaluate its potential risks, benefits, and supporting evidence.
The Right Starting Point Matters
Concussion rehabilitation is not simply about doing more exercises or beginning treatment as quickly as possible.
It is about identifying the injured systems, understanding the brain’s current capacity, and selecting an appropriate starting point.
For one patient, that may mean beginning vestibular exercises. For another, the first priority may be managing headaches, improving sleep, addressing neck problems, or reducing the demands placed on an overwhelmed brain.
The treatment plan should then change as the patient’s function and tolerance improve.
No two brains, injuries, or medical histories are exactly the same. Effective concussion care requires more than a diagnosis—it requires understanding how that particular person’s brain is functioning and building recovery around what the testing reveals.
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